"The time has come," the Walrus said, "To talk of many things: Of shoes and ships and sealing wax, of cabbages and kings. And why the sea is boiling hot, and whether pigs have wings."--- Lewis Carroll

Tuesday, April 11, 2006

How Bureaucratic Bungling Hurt One California Child

What would you do if your child broke his or her arm at school and no one had the common-sense to call the paramedics? That's what happened the other day in the border town of Calexico, California: (emphasis added)

When Luis A. Acosta got a call from Jefferson Elementary School officials informing him his child was hurt, he did what most parents would do: he panicked and rushed immediately to pick up his son.

Acosta called his wife, Hortencia, after he saw his son’s injury and told her he was taking Luis David, 6, to a hospital in Mexicali immediately as the family had no medical coverage.

While their son underwent surgery to repair the compound elbow fracture, the Acostas began to question why school officials did not call emergency services the afternoon of March 22.

“The bone was sticking out from the inside of the elbow,” said Hortencia N. Acosta. “There was no splint on my son’s arm when my husband picked him up, just a Band-Aid.”

Jefferson Principal Norberto Nuñez was asked why emergency workers were not called to the school when the kindergartner was injured after being pushed off the slide by another student.

“(The decision was) based on the assessment by the health clerk that it wasn’t an emergency,” said Nuñez.

Hortencia Acosta disagreed vehemently.

“As a mother I am worried and upset. What has to happen before they call emergency services? Does he have to have his guts hanging out?” she asked.

Acosta said she asked Nuñez those same questions but received few answers that satisfied her.

“It was a fracture and broke the skin. His bone was sliding out,” said Acosta.

Nuñez was asked to verify the severity of the injury.

“All I can tell you is it was a broken arm,” said Nuñez.

When asked of the school or district policy on injured students, Nuñez responded that implementation of school policy depends on the severity of the injury and professional assessment by the school health clerk.

Gina Sanchez, Calexico Unified School District assistant superintendent of Academic support services, said, “I am aware of the incident. However, until we receive a report from the site I can’t answer the reason why emergency services weren’t called.”

Sanchez confirmed that each school site has an instruction handbook for reference on emergency procedures.

A copy of the CUSD handbook provided to the Imperial Valley Press reveals a section that deals with emergency guidelines.

Section 45.2 states “First aid is the immediate and temporary care given to an injured or ill person. It may consist of as little as helping a student dust himself off after a playground fall to the more complicated procedure of providing the student with transportation to the El Centro Regional hospital emergency room. At all times we are called upon and have the responsibility of using our best judgment in providing assistance and care to our students.”

The handbook provides detailed guidelines on the exercise of judgment by staff in regard to appropriate first aid treatment and defines staff responsibility as to when to contact parents or whether to request emergency services.

The guidelines state that it is the office staff’s responsibility to contact parents as soon as possible and/or transport the injured student to a medical facility when it is deemed necessary and no contact has been made with parents. The guideline also directs office staff to request paramedics’ assistance when judged to be necessary, except when overruled by the parents and it is not a life or death situation.

El Centro Regional Medical Center emergency physician Richard Obler placed the medical diagnosis of the injury — an open supracondylar fracture of the left humerus with dislocation and rotation with local neurovascular compromise — in laymen’s terms.

“An open supracondylar fracture is a compound fracture of the upper arm near the elbow. The skin was broken and the bone was briefly exposed to the outside. Neurovascular compromise means the nerve or blood vessel was damaged. This type of injury requires urgent surgical correction and cleaning to prevent infection.”

Luis David, 6, underwent surgery in Mexicali on March 22 and his parents are faced with a debt of more than $5,000 for treatment. The Acosta family submitted it expense receipts on Thursday to Sanchez and requested an inquiry into the measures taken.

The incident remains under investigation by CUSD officials.

Was this an extreme case of C.Y.A., a poorly-trained staff member, or simple incompetence?

In my 14 years of classroom service here in California's "Imperial" Valley, I've seen quite a bit. But this is strange even by our standards...

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